Our Impact

Hearing devices are the primary treatment for hearing loss and the NHS is the largest purchaser of hearing aids in the world (1.2m p.a.) but there is no UK centre that specialises in hearing device research. Hearing device industries therefore have no coordinated UK contact, and there is a lack of critical mass in UK hearing device research.

Manchester BRC has established the UKs only Hearing Device Research Centre (HDRC), commended by our international Scientific Advisory Board to drive innovation in interventions for hearing loss, facilitating and accelerating translation into the NHS.

We have built a robust infrastructure, unique within the UK, utilising key BRC functions of cross-cutting themes, academic support, and industry partnership. For example, we are working with colleagues in material science to develop an implantable graphene microphone, and with the University of Salford have applied to the Engineering and Physical Sciences Research Council (EPSRC) to study accessibility of broadcast and television for listeners with hearing loss.

An NHS-based audiologist has completed a six-week BRC research taster, providing extra data collection capacity for an existing project. A second research taster session is now working with an NHS-based audiologist using our speech-in-noise test to improve management of a paediatric population with unilateral hearing.

We have established dialogue with many leading device companies, confidentiality agreements have been put in place and we are receiving technical support and payment-in-kind.  Industry partners include Sonova AG, who selected HDRC as its preferred partner for their research and funded an initial study on subjective benefits of deeply inserted extended wearing hearing aids. This also funded a Manchester workshop on health psychology and hearing, attended by international experts in academia and industry. We have also worked on a clinical service delivery model project proposal with Oticon to be submitted to the Oticon Foundation (Sept 2019). A Research Audiologist has been appointed to facilitate our industry-funded studies.

Work in the HDRC has ranged from new algorithms to applications submitted to UK Patent Office for our infant hearing assessment project that uses facial recognition software and machine learning (Patent Pending GB1817803.8). We completed a preliminary study on direct-to-consumer hearing devices to support our upcoming Programme Grants for Applied Research (PGfAR) application on ‘Internet adult hearing screen and remote e-health interventions’ (Sept 2019). Our first study determining cochlear implant candidacy based on electrically-evoked brainstem activity is published (Causon et al.  2019) and we employed a Healthcare Scientist to take this project forward. Building on our health psychology collaborations, we also received a grant from International Hearing Industry Research Consortium to investigate stigma and hearing aid use.

The HDRC is already making a direct impact on patient lives across the country; the ‘Listening Test Room’ is now fully commissioned and we have been awarded a contract with NHS Supply Chain to host and support evaluation of new hearing aids for the NHS as part of the five-year NHS tender process.

We are collaborating with Nottingham BRC and University College of London Hospitals (UCLH) BRC to strengthen national infrastructure including an NIHR Health Informatics Collaborative in Hearing Health and a Hearing Medicines Discovery Syndicate (supported by the Medicines Discovery Catapult, Royal National Institute for Deafness (RNID, formerly Action on Hearing Loss) and NIHR Office for Clinical Research Infrastructure (NOCRI).

Digital healthcare technologies such as genomics, digital medicine, artificial intelligence (AI), and robotics enable new opportunities for addressing the big healthcare challenges of the 21st century.

The UK has the potential to become a world leader in these healthcare technologies but, as discussed in the recent Topol Review, it will impact the roles and functions of healthcare staff over the next two decades. Within 20 years, 90% of all jobs in the NHS will require some element of digital skills. Staff will need to be able to navigate a data-rich healthcare environment. All staff will need digital and genomics literacy.

The NIHR Manchester BRC aims to be at the forefront of training and capacity building of healthcare researchers and staff in digital technologies, building on strengths that exist in this area within The University of Manchester (UoM). We recently devised a one-day course in data science and programming skills for undergraduate medical and healthcare students. The course was led by experts in data science at UoM and focussed on Python programming and data analysis using Jupyter notebooks. A publicly available dataset on antibiotic prescribing in English general practices was used as example. The course was also available to BRC PhDs and BRC Clinical Fellows.

Attendees were tasked with analysing the dataset using Python to identify, for example, the most common antibiotics prescribed in a certain timeframe and which areas of the UK prescribed the most. The day focussed on the cleansing, management, analysis, and visualisation of data. The use of a single dataset throughout the workshop, reflected the data management, analysis and workflow that a researcher would most likely apply.

The course was attended by 22 people from different programmes and different backgrounds. Evaluation of the course showed that attendees had gained the ability and confidence to write small programs to solve data analysis problems. They valued the ability to use the Python programming language because of it makes their analysis easier to replicate. Attendees felt confident that they could apply what they have learnt to their studies and research. All attendees said they would recommend the course to colleagues.

As a next step, we will make this course available to a broader range of entry level undergraduates as well as established health professionals. The training will also be expanded to cover issues such as structure and storage of data, and information governance. As such we will build competencies aligned to the Health Education England’s Digital Literacy framework.

Research funded by the NIHR Manchester Biomedical Research Centre (BRC) has led to UK-wide implementation of a novel NHS diagnostic test that uses pyrosequencing (a method of identifying genetic markers in DNA), to identify the right treatment for people with aspergillosis.

Aspergillosis is a serious respiratory infection caused by Aspergillus mould that can affect people with a weakened immune system, damaged lungs or allergies. Invasive aspergillosis (IA) can cause death within a few days to weeks, while chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) are progressive conditions causing gradual destruction of airways.

Aspergillosis rates have increased in recent years, with 200,000 CPA and 1,062,000 ABPA cases in Europe alone, and 50-85 per cent CPA mortality within 5 years.

Standard treatment is the triazole class of antifungal drugs. However, growing numbers of studies show a transcontinental trend in resistance to these medicines due to long treatment courses (CPA requires at least six months therapy) and agricultural use – with a slow rate of new treatments available.

Professor Malcolm Richardson, NIHR Manchester BRC project lead in fungal research and Consultant Clinical Scientist in Mycology at Wythenshawe Hospital – part of Manchester University NHS Foundation Trust (MFT), said:

“Early and accurate diagnosis of antifungal resistance is vital to improve patient outcomes now, and in the future. This is why Manchester BRC set out to find a way to detect this antifungal resistance in patients with aspergillosis that could be applied as part of routine clinical care.”

The research compared the pyrosequencing technique against high volume cultures (HVC).

HVCs are grown in the laboratory from mould present in a patient’s sputum (saliva and mucus). It can take 10 days for enough culture to grow for analysis of antifungal resistance and in some case the culture might not grow at all. This new pyrosequencing procedure can be carried out from start to finish in three to four days.

The novel pyrosequencing test analyses the genetic molecules (DNA) of the Aspergillus mould, taken directly from a patient’s sputum and can detect mutations in the fungus that reveal if it will be resistant to certain antifungal drugs.

In one comparison example, around 50 per cent of samples from patients with CPA who were failing on treatment did not grow a culture so conventional antifungal testing was not possible. However, pyrosequencing allowed detection of mutations in the DNA of Aspergillus directly in the clinical sample.

The National Aspergillosis Centre (NAC) based at MFT consults on approximately 500 CPA patients annually. Dr Caroline Baxter, Acting Clinical Director of the NHS National Aspergillosis Centre (NAC) said:

“The importance of the introduction of this test in the NHS cannot be underestimated, not just for the clear patient benefits it brings, but for the major impact it has on the long-standing challenge of early detection of antifungal resistance. This test allows for prompt recognition of antifungal resistance and will quickly give doctors the information they need to plan the most effective treatment for their patients.”

The test was accredited by UKAS in summer 2019. The NHS Mycology Reference Centre Manchester (MRCM) is delivering the service for UK and European clinical teams and is ideally positioned to provide this diagnostic as it provides fungal diagnostics as a hub laboratory to several UK satellite aspergillosis clinics.

The MRCM and the NAC are currently in discussions with NHS England Specialist Services Commissioners regarding the expansion of these services.

‘Deciphering Aspergillus fumigatus cyp51A-mediated triazole resistance by pyrosequencing of respiratory specimens‘ has been published in the Journal of Antimicrobial Chemotherapy.

In the UK, around 71 per cent of eligible women take up their breast screening invitation. South Asian women in the UK are less likely to attend screening than any other BAME groups. In particular, British-Pakistani women have poor uptake to breast screening invitations and are more likely to live in deprived areas.

Researchers from the Manchester BRC Cancer Prevention and Early Detection  looked at how breast screening could be made more accessible to British-Pakistani women, a less-well listened to population.

To explore the reasons behind this, health psychologists interviewed 19 British-Pakistani women from East Lancashire to explore their views on attending routine breast screening.

Five key recommendations were suggested based on these interviews:

1. Reinforce the message that breast screening is a female only environment. Only a female member of staff will perform the mammogram.
2. Awareness needs to be raised with regards NHS translation and interpretation services to enable women to get the most out of all NHS appointments, not just breast screening.
3. The NHS should consider recording language and communication preferences to improve access.
4. The breast screening service should work together with communities as a valuable source of support and information for women.
5. The breast screening service should involve BAME women in the creation of screening materials to enable accurate translations to improve accessibility.

Positive changes have already been made since our research. Invitation letters now include the term ‘breast x-ray’ and state that they are performed by female staff only. In summer 2019, the Greater Manchester screening service employed two cancer screening improvement leads funded by the Greater Manchester Health and Social Care Partnership (GMHSCP). They work in deprived areas with communities to provide support and information about screening.

 

The below PHE blog explores the key issues encountered by British-Pakistani women and also makes further suggestions on how to mitigate barriers to screening:

Making breast screening more accessible: views from British-Pakistani women

 

As part of this piece of work, women were also asked for their views on a risk-stratified breast screening service, which could provide women with a personalised risk score of their likelihood of developing the disease. These women were positive towards such a service but provided insight on potential barriers they could face. This focused on three main themes:

1. Attitudes towards risk awareness
2. Anticipated barriers to accessibility
3. Acceptability / strategy of communicating risk to women

You can find out more about personalised breast cancer screening in a blog from BRC Researcher Vicky Woof 

 

Links to the associated papers:

• https://journals.sagepub.com/doi/full/10.1177/0969141319887405
• https://link.springer.com/content/pdf/10.1186/s12885-020-06959-2.pdf

Findings for these studies are informing a wider research study called BC-Predict, co-led by Professor Gareth Evans, Cancer Prevention and Early Detection Theme Lead for Manchester BRC and Professor of Health Psychology, David French. This is testing the use of an online health and lifestyle questionnaire which, when combined with breast density information from a mammogram and genetic testing, can produce a personalised risk score for women attending screening.

The Psoriasis Rapid Access Clinic (P-RAC) opened in January 2019 and is led by Professor Chris Griffiths, Director of the Manchester Centre for Dermatology Research and Dermatology Theme Lead for the Manchester BRC.  The Salford-based clinic is an innovative, community-based and consultant-led clinic, which provides integrated management to newly-diagnosed psoriasis patients who receive very early access to specialist and personalised care within weeks of diagnosis.  It is a unique collaboration between NIHR Manchester BRC, the NHS Salford Clinical Commissioning Group (CCG) Innovation and Research Oversight Group and The University of Manchester under the umbrella of the Greater Manchester Health and Social Care Partnership (GMHSCP) and Health Innovation Manchester.

Early disease is a key time for intervention from a patient perspective, preventative model and population health point of view – and our research has demonstrated a positive shift in patients’ understanding and sense of control over their health.  What is particularly innovative about this clinic is that people with psoriasis are rapidly referred by GPs to expert care early in the disease cycle; something that hasn’t been done for psoriasis previously and has the potential to revolutionise care of this common disease.

P-RAC has its roots in the NIHR-funded Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme which investigated the other diseases that people with psoriasis often suffer with (known as co-morbidities), the coping strategies used by patients, and the barriers encountered by healthcare professionals to providing behaviour change advice to patients.

Most patients develop psoriasis before the age of 35 and, with time, they can accumulate physical, psychological and socioeconomic morbidity as a consequence. Using NHS datasets and in-depth research, IMPACT found that unhealthy lifestyle behaviours are increased among people with psoriasis including smoking, excess alcohol consumption and increased body mass index (BMI), while many faced a long wait for specialist assessment and disengagement from health services.

The PsoWell® training programme for healthcare professionals, co-developed with patients, was a product of the IMPACT programme and aimed to enable a patient-centred focus that facilitates health behaviour change and improves care and outcomes. It provided personally relevant materials to psoriasis patients that enabled them to live well and reduce likelihood of acquired comorbidities.

The P-RAC clinic is highly proactive with respect to these comorbidities and screen for depression and anxiety, psoriatic arthritis and risk factors for cardiovascular disease. All patients receive psychoeducational resources, including information about lifestyle factors which can increase the risk of flare ups, practical advice about topical therapies and details of available treatments.

Patients are reviewed by a health psychologist, who can signpost patients to additional hospital or community support as necessary, including community-based social prescribing services. Those with moderate-severe psoriasis are identified and fast-tracked to hospital services for early intervention with systemic therapy. Those suitable for topical monotherapy are discharged to their GP at the end of the intervention, with a clear management plan and links to the local psoriasis management pathway are highlighted to facilitate GP education.

Results to date demonstrate that patients attending this clinic have significant comorbidities, which need to be addressed. Patients reported an improved understanding of their psoriasis, the treatment prescribed, and sense of control over their condition. They were also more motivated to learn more about psoriasis and make healthy lifestyle choices.

A variety of patient and physician reported outcome measures were improved upon within four weeks of attending this clinic. These results have been accepted for presentation at the British Association of Dermatologists annual meeting and the European Academy of Dermatology and Venerology annual meeting.

This has significant health and social care economic benefits – including reducing work absence and attaining appropriate education. Another important innovation is that this group of patients – early in their disease course – are unique to dermatology research centres and provide an important opportunity for prospective studies on how the immunology and epigenetics of the disease may change with time. The team are currently profiling these patients by collecting biological samples for future genomic and proteomic research.

Almost half of cancer patients undergo some form of radiotherapy during their treatment. The Christie, part of the NIHR Manchester Biomedical Research Centre (BRC), delivers radiotherapy to around 8500 patients each year. However, we found that patients and researchers felt that it’s not talked about as much as other treatments, including the possible side effects.

‘Radiotherapy & Me’ was a creative project designed to share real-life experiences of radiotherapy, inspire conversations about radiotherapy as a safe and effective treatment, and raise awareness of research within Manchester BRC’s Advanced Radiotherapy theme.

Led by Vocal, the six-month project was a collaboration between cancer patients, researchers and health professionals, supported by creative practitioners from Manchester’s Contact Theatre.

Oldham, a town in Greater Manchester, was chosen as the site for the project to prioritise an area where there is traditionally low participation in translational research. The Royal Oldham Hospital also hosts The Christie at Oldham, which delivers a range of radiotherapy treatments closer to home, rather than patients having to travel to the main Christie hospital in South Manchester.

Patients and members of the public were invited to a series of workshops at Oldham Library. Together with researchers and creative practitioners, they were encouraged to reflect and capture their experience of the treatment through sessions in creative writing, spoken word, poetry and visual arts. This culminated in a showcase event at the library, where these exhibits were shared with members of the public through visual displays and audio recordings.

Vocal also created a series of video interviews with people who had experienced radiotherapy about their unique experiences of the treatment. The films and audio stories from are available online and have been shared with both regional and national health provider charities, to encourage more people to talk about radiotherapy and to promote involvement in research.  So far we’ve reached over 700 people.

Posters promoting these resources will be displayed in outpatients clinics at The Christie, as well as hospitals in Manchester, Macclesfield, Oldham and Salford, to support current patients, and their families and friends, to feel supported as they go through this treatment and experience.

Vocal continues to promote this work to wider patient and public involvement and engagement (PPIE) and cancer research networks.

The University of Manchester has also included the videos in training programmes within the Faculty of Biology, Medicine and Health (FBMH). Wider afield, they have also been promoted across the Clinical and Translational Radiotherapy Research Working Group (ctRAD) network of over 160 UK radiotherapy researchers. We have seen continued engagements through participation in other PPIE panels and events.